Monday Morning Crisis Quarterback

Anyone who's ever had any kind of emergency training at all has heard some version of the same speech.  "Before you try to help," it goes, "make sure that you yourself can assist safely.  Do not become a casualty yourself."  In a Red Cross CPR class, this comes in the form of the reminder to "Check, Call, Care," that is, check to make sure it's safe before you do anything else.  In a lifesaving swim class, it takes the form of "Reach or throw, don't go," meaning don't get into the water if you can help the struggling swimmer any other way.  CISM has a similar principle, usually expressed along the lines of, "If the incident is personal for you, get someone else."

I bring this up because on Tuesday I was assisting with a response and became a casualty myself, although not, perhaps, in the way you would think.

Earlier this week, a family from Ann Arbor was involved in a major car accident in Virginia.  The mother, Theresa Supica, and one of the daughters, Samantha, were killed, and two other daughters are in the hospital.  The girl who was killed was a student at Slauson Middle School in Ann Arbor, where I am the training coordinator for the CISM teams.  Tuesday night, the team leader for that part of the district had organized a crisis management briefing and general get together for the middle school community as well as the associated elementary schools and the high school the sisters attend.  It was outside on a large patio in front of the middle school.  She asked me to attend as one of the supporting members of the team, which I was happy to do.

Tuesday was a pretty hot and humid day in Ann Arbor.  After work I went to a weight lifting class and, despite the air conditioning, we were all sweating profusely.  About three quarters of the way through the class I started to feel somewhat nauseous, so I sat out in the hallway (where it was a little cooler) for the end of class and felt much better.  I hopped in my car and headed towards Slauson, about 10 minutes away.

Half way there, my stomach started to feel icky again.  I realized I probably should stop driving, and that I wasn't going to be much use at the CMB.  My cell phone was dead, so I thought I'd get to Slauson and find someone I knew to call my husband to come get me.  I pulled into the parking lot, got out of the car, sat down in the grass near my car and, not seeing anyone I knew in the immediate vicinity, flagged down a stranger who was just arriving.

I don't know what I looked like at this point, but it can't have been good, because the woman immediately looked alarmed and said, "What's wrong?"  I asked her to call my husband, and she went to get her cell phone out of her car.  By the time she returned, I was vomiting in the grass, breathing very heavily and losing feeling in my hands.  The woman called 911.

At this point I was pretty much doing a face plant in the grass.  I could hear everyone and I knew what was going on, but I couldn't move and felt just ghastly.  I could hear the woman trying to give directions to where we were, estimating my age ("middle aged" -- I was a little disheartened) and asking if I'd ever had a stroke "before."  When the paramedics arrived and got me onto the stretcher, I was shocked to see that quite a crowd had gathered.  It hadn't occurred to me that I was causing such a ruckus.

To make what is already a long story a little shorter, after 5 hours in the ER and all sorts of tests, the only thing wrong with me was dehydration.  I should know better.  Apparently, however, I don't.  I was embarrassed to have caused such a scene. 

More than anything, however, I knew that I had caused a scene in a place where people did not need more drama.  A community reeling from the sudden death of one of its own does not need the image of a relatively young (OK, middle aged), relatively healthy person being wheeled into an ambulance.  They don't need to hear sirens.  They are working on believing that the world is a safe place once again, and my little episode underlined that maybe it isn't.

To the friends, neighbors, teachers and family of Samantha Supica, I send my heartfelt apologies.  I became a casualty myself.  You have my deepest sympathies and my sincerest regrets.  Thank you for helping me when I should have been helping you.

I took my first Critical Incident Stress Management training class in 2003.  It was offered through my school district and taught by two social workers from the county department of Community Mental Health.  One of them was Gary Logan.  Gary was, among other things, the coordinator of the county community CISM team, called the Traumatic Events Response Network (TERN).  At the end of the class, he solicited volunteers who wanted to join the team.  I signed up.

I'm not sure that Gary knew what to do with me at first.  There are two categories of CISM responders:  mental health professionals and peers (some would argue that there's also a third -- clergy).  TERN, at that point, was entirely made up of mental health professionals because there was no one population it served.  Where a team assisting police officers would have cops on it as peers, a team assisting all kinds of people doesn't know what kind of peers it needs.  For the first few years, I was only tapped to respond when there was a crisis involving children or schools. 

Gary and I consulted and worked with each other more frequently when he came to assist our district team -- which needed lots of school personnel as peers -- with crises in our schools.  He was very interesting to watch and work with.  He had a calm about him in everything he did, and it put people at ease.  I learned from him how to explain complex psychological processes in language people could understand, how to grasp themes from what people were saying, and how to firmly state what you think is the right thing to do and accept that sometimes those in charge are not going to listen to you.  I never saw him sweat.

A few years ago, when I decided to pursue a Certificate of Specialized Training in schools and children crisis response, I asked Gary to please include me on more critical incident stress debriefings, and he did.  He started assigning me to respond as a peer outside of schools -- in community settings, businesses, and even responding to a group of mental health professionals from his agency following the murder of a client.  When I floated the idea of becoming a CISM instructor, Gary wrote my recommendation and told me he thought I'd be great.

Over the last couple of years, Gary has invited me to substitute for him as the coordinator on call for the county team and even allowed me to coordinate a couple of responses myself, something I do as a peer in a school setting all the time but a rarity out in the "real world."  He has expressed faith in me at every turn, strongly encouraging me to take on whatever I could, expand my consulting and, most recently, start considering earning a mental health degree myself.  His confidence in me has been astounding, and it has increased my confidence in myself.

Over the years I have needed assistance more than once with crises in which I was affected myself.  Gary was always my first call.  Watching him from the "other side" of a response was amazing, and his support was so helpful to all of us.  Whether I was responding or being responded too, Gary always reminded me to take good care of myself, and knew that I wasn't always so good at it without his reminders.

Gary retired when his department was cut at the end of last year.  He continued to coordinate TERN as a contractor.  Yesterday, he died suddenly during treatment for heart disease.  He was 63.  I doubt there will ever be anyone with as much faith in my crisis response skills as Gary.  I also doubt there will be anybody I so readily call on in my own time of need.  In fact, this morning, after I heard that he had died, I found myself wishing more than anything that I could talk it over with my friend and mentor, Gary Logan.

You've all heard the story.  On October 30, 1938, CBS Radio aired an adaptation of H.G.Wells' classic "The War of the Worlds," narrated and directed by Orson Welles.  It caused widespread panic, because listeners thought it was real.  The first chunk of the show was in the format of news bulletins and there were no commercials, and people freaked out.

I bring this up because Imedi TV in the country of Georgia broadcast a "simulation" of a Russian invasion of Georgia last night.  They used actual clips of Vladimir Putin and Dmitry Medvedev and footage shot during the Russian-Georgian conflict in 2008.  They, too, used simulated "news bulletins" to further the story.  They didn't announce it was fictional beforehand, and nothing at all on the screen let viewers know it wasn't real.  They noted it was simulated at the end of the broadcast.  People freaked out.

It's probably fairly tempting to think that there is no harm done here.  I mean, yes, they scared people, but now that people know it wasn't real everything's fine, right?  Wrong.  Fake trauma can be truly traumatic.  People can and are traumatized by the belief that they are in serious danger.  If you think you're about to die and then don't, you are (at least most people would agree) better off than if you think you are going to die and then do.  But you aren't necessarily OK. 

People who have experienced situations where they truly believed they were in danger exhibit all the same symptoms as people who actually have been in danger.  They have trouble sleeping, intrusive thoughts about the incident, difficulty concentrating, changes in appetite, irritability, and on and on.  They have increased fear of whatever the situation was that scared them (e.g. getting in the car if they thought they had a close call in the car).  What's more, because whatever scared them turned out to be fake, they are less likely to use the resources that help people in such situations, like talking to a friend or even writing their feelings in a journal.

So, given the history of "War of the Worlds," which I can't imagine they didn't know about, and the possible ill effects of scaring the pants off of people, why would Imedi TV do this?  Of course I don't know for sure.  The station is referred to as being "pro-government," which I guess is as opposed to "pro-Russian."  One can imagine the government doing this intentionally to stir up fear of a Russian invasion, and cause people to look to the government to protect them.  One can also imagine someone just being really stupid in making a programming decision.  Whatever it was, this shouldn't have happened.  It wasn't harmless.

At about 1:45 this afternoon, a 9th grader at Discovery Middle School in Madison, Alabama pulled out a gun in the middle of a crowded hallway and shot fellow 9th grader Todd Brown in the head.  Brown is in critical condition, and the other student is in custody.  No information about a possible motive has been released.  The news coverage of this event provides an interesting view into how schools respond in a crisis and how things actually unfold.  It is also notable for what is missing from the coverage.

From the reporting, we can gather the following:  When the shooting occurred, other students ran into nearby classrooms.  At least one of those classrooms had a substitute teacher who did not have keys to lock the door.  I can say as an administrator that this is a real problem in schools.  Ideally, everyone who unlocks a classroom door, whether the regular teacher, the sub using a borrowed key, the custodian or anyone else, ought to leave the door so that it locks when it is closed.  However, few people do because they don't remember, don't think it's important, and students and colleagues can't come and go from the classroom if the door is closed without the teacher having to constantly let people in.

After the crowd scattered, the school went into lockdown.  The purpose of this is twofold -- to make sure that everyone is accounted for and the shooter has limited access to other victims, and to keep people out of the way of emergency personnel.  Few people think of it, but you might well put a school into lockdown if a child had a medical emergency in the hallway, too.  The school nurse and the school resource officer (a police officer stationed in the school) were there within seconds.  Emergency personnel were on scene within 3 minutes of the shot, which is one of the advantages of a school being directly across the street from a fire station. 

By this point, the kids who were in the classrooms were already texting each other to find out what everyone knew about what had happened.  They were also texting their parents, who can be seen in the news photo above waiting anxiously outside the school.  The days when information control was in the hands of the person who had access to the PA system are long gone.  The school was able to start releasing students approximately half an hour after the shooting, which is phenomenally fast and speaks to the efficiency with which everyone involved was working.

Here's what isn't in the coverage, but what is almost certainly true.  The shooter almost certainly has a disciplinary record, a truancy record or had already come to the attention of the administration.  If his target was not chosen at random, then chances are the victim also has a backstory.  In my experience, when horrible things happen involving kids, no matter how random it may seem, there is a 9 out of 10 chance that there is something about the child, their family, history or background that makes the situation less simple than it appears.

Also, unless the victim was chosen at random, many people at the school know what the motive was.  The fact that it's not being reported doesn't mean no one knows, it means they've been told not to tell.  There is no way this happened in a crowded hallway between two students who knew each other without either a witness or someone else connected to the people involved knowing why this happened.

The Principal at Discovery Middle School, any other administrators, and the counselors or other crisis team members have had a terrible day.  Chances are good that, while they have been busy setting up counseling for the students, no one has yet checked in on how they themselves are doing.  Chances are also good that they are not cutting themselves any slack or making sure that they take care of themselves.  This is the nature of this type of incident and of people in this kind of position.  We are trained to care for kids, but we're horrible at caring for ourselves and each other.

Even if the administrators and crisis responders are getting a little TLC, there's about a 85% chance that no one has looked in on the secretary, or even noticed what her day was like.  She spent the afternoon fielding panicked phone calls, fearing for her own safety and getting barked at by just about everyone.  She had a lot of the responsibility of coordinating the situation, but probably much less information or control than her superiors.  If there was a staff meeting to discuss the days' events, she probably was not invited.

Obviously I am speculating about the shooter, the victim and the staff at the school.  I have no actual information.  For all I know, these folks were just as well prepared for the aftermath of the day as they were for the immediate response.  What I can say is that if that is true, it is unusual.  Unless you've had the misfortune to go through something like this several times, there are lessons that you just haven't learned yet.  It's unfortunate that anyone has to learn them at all.

Update:  The victim, Todd Brown, died on Friday evening at about 8 PM.  The shooter has been charged with murder.

Spoiler Alert: If you haven't read the 6th Harry Potter book or seen the movie and you are planning to, don't read this. It gives away the ending.

This week I took my 11 year old daughter to see "Harry Potter and the Half-Blood Prince," better known in my house as "the 6th movie." To say that she is a Harry Potter fan would be to greatly underestimate her complete immersion in the books and the previous 5 movies. She was an early reader, and I read her the first book in early 1st grade. She read the rest of them herself, including finishing the final book in less than two days (after, of course, staying up with me until midnight and dressing in character to pick up our two copies at the bookstore the day it came out). She has probably read the 6th book the equivalent of 50 times, when you include all the going back and rereading favorite parts in addition to reading the whole thing. She has never been the slightest bit scared of anything she read.

So on Wednesday when we went to the movie on opening day, I was rather surprised by the sounds I heard coming from the chair next to me. She was scared. Not terrified to the point of needing to leave, but really scared. She was whimpering, curling her legs up in her chair, and shaking during the scary parts. But she loved it, and as I write this she's off with her father seeing it again.

Why was the movie so very much more terrifying to her (and to me, by the way) than the book? It's not like she didn't know what was going to happen or how it would end. She's certainly old enough to know that it's fiction. Why was her reaction so extremely different between the movie and the book, or even between this movie and the previous five movies?

I think there are two things going on here. The first has to do with the means of receiving the story. When you read a book with no pictures, it is up to you to "see" the story for yourself. Some people do much more of this than others when they read, but all of us do it to some extent. We imagine what the scene looks like as it is described. Our brains are really pretty good at preventing us from "seeing" things as being particularly frightening. We have an internal censor that just blips past the scariest images. We know they happen in the book, but we don't experience them as intensely because our brains won't let us. When we see a movie, however, we don't have the luxury of toning down the frightening parts. Someone else, not our own brains, has made the images, and they're not adjustable based on how scared we are. In a film, we have the sensory experience of whatever is frightening to us, not just the imagining of it.

The sensory exposure issue ought to be the same for all the movies, however. The scariest parts to every movie are scarier than the scariest parts of the corresponding book. Was this book really that much more scary than the first five? Yes, but not for the reasons you might think. To a true Harry Potter lover, Dumbledore is very real. Yes, my daughter knows he's fictional, but he is a very beloved character. She was genuinely sad when he died in the book. Watching the movie, anticipating that he was going to die, elicited an emotional reaction that didn't exist in any of the previous movies. She was not as attached to Sirius Black, who dies at the end of the fifth book/movie, or Cedric Diggory in the 4th, and all the other ones she knew that "everything comes out all right in the end." That isn't true in this movie. Everything is not all right in the end. It was scary, and in the end it was going to still be scary and sad. Knowing that removed one of her best tools for consoling herself.

I'm not sorry I took her to see this movie. She isn't having nightmares about it or otherwise dwelling upon it and, as I mentioned, she wanted to see it again. I suspect the second time will be a little easier, because she'll have seen it all before. But it does serve as a reminder to all of us that there are things that are better read about or listened to than seen, and when in doubt we should probably be protecting all of us, not just our children, from unnecessary sensory exposure to violence and tragedy.

I recently exchanged emails with the coordinator of our county CISM team. I had been approached to assist an acquaintance who recently was in a serious car accident, and I was checking in with him before doing so. Think of it as analogous to a police officer being asked to investigate a crime -- you wouldn't just go off and do that without notifying your commanding officer, no matter how wonderful you think you are. The following is a piece of the reply I received:

I think that one of the areas leaders in CISM can have a positive impact on others is encouraging and role modeling good self care. From what I’ve observed, you may have some growing to do in this one area.

He then proceeded to caution me about the risks of responding to incidents that affect me or with which I might particularly identify.

I thought that was one of the most carefully and diplomatically worded pieces of constructive criticism I have ever received. Someone a little less tactful, such as, say, me, might well have written, "When will you ever learn? You really stink at knowing when you are too close to a situation." I appreciated the skillful word-craft.

So, in the interest of having a positive impact on my readers, here are some thoughts on self-care. My coordinator might add that you should do as I say, not as I sometimes do!

As my regular readers know, secondary trauma is a big risk for those who work in trauma response. I often describe it like this: Trauma is a steaming pile of manure (OK, I don't use the word manure, but this is a family friendly blog). When you help someone who has been traumatized, you help them shovel their manure. But there's only so much manure you can shovel without getting some on you. At some point, you have to stop and take a shower.

Now that you all have that lovely visual image . . .

It's true, though. Other's trauma traumatizes us. Every single CISM team member should be taking good care of their body, mind and spirit after every single response. There is no such thing as, "I don't need to, I'm fine." There is only, "I need to" and "I really need to." What that self-care looks like is highly individualized, but it closely mirrors what we advise for the traumatized people themselves: get exercise; eat healthy food; access your support network of friends, family and faith; do more of whatever you do to decompress (because ironically the more stress we are under the less we feel like doing the things we know help us); steer clear of alcohol and drugs; give yourself time.

I have never been bad at doing those things. What I'm really bad at is recognizing when I need to step back altogether. Because I am passionate about this work, I have strong opinions about how it is done. It's hard to care that much and then say that I myself will not be doing it. I once likened it to watching someone else parent your child -- it's hard not to be involved. But I also know, even if I need to be reminded, that when an event impacts me or my school community or the people I love significantly, I just can't be part of the response.

When airlines do the demonstration of oxygen masks before takeoff, they remind you to put on your own mask first and then help others. The same goes for crisis response. We're no good to anybody until we're good to ourselves, and sometimes that means referring incidents to someone else.

There, does it seem like I've done some growing in this one area?